“Sometimes People Don't Fit in Boxes”: Attitudes Toward the Minimum Data Set Among Clinical Leadership in VA Nursing Homes

Objective

To describe attitudes toward the Minimum Data Set (MDS) among Department of Veterans Affairs (VA) nursing home care unit (NHCU) clinical leadership.

Design

Cross-sectional online survey using structured (quantitative) and open-ended (qualitative) items.

Setting

Approximately 97 VA Medical Center NCHUs nationwide.

Participants

A total of 289 directors of nursing, medical directors, MDS coordinators, nurse managers and other clinical management staff.

Measurements

Quantitative ratings of the MDS's accuracy, usefulness for initial and ongoing care planning, and utility for quality improvement; content analysis of open-ended items describing perceived causes of inaccuracy and reasons for use/nonuse in care planning and quality improvement.

Results

Although quantitative ratings were generally positive, qualitative analysis yielded a number of emergent themes regarding data accuracy, team functioning, timeliness of assessments, and validity of the MDS tool itself. Medical directors were somewhat less positive about the MDS than were other NHCU leadership. Very large and very small facilities were less likely to view the tool as useful and to use it for care planning and quality improvement.

Conclusions

NHCU clinical leadership clearly has a “love-hate” relationship with the MDS. They value information it provides, but identify a number of weaknesses that limit its utility for clinical use.

Keywords: Minimum Data Set, staff attitudes, veterans